基于转型冲击模型的精神专科医院新入职护士培训方案的构建

目的 构建精神专科医院新入职护士培训方案.方法 以转型冲击模型为理论基础,进行文献回顾,对精神专科医院2名护理管理者、6名临床护理带教教师和4名正在接受培训的新入职护士进行半结构式访谈,初步形成精神专科医院新入职护士培训方案,采用德尔菲法对25名专家进行2轮函询.结果 2轮函询问卷有效回收率分别为96％(24/25)、...     

本科学历新入职护士临床轮转考核评价体系的构建

目的 构建本科学历新入职护士临床轮转期间全过程考核评价体系.方法 通过文献回顾、专家小组讨论初步拟定指标条目,采用德尔菲法,选取从事临床护理(带教)工作、护理管理工作、护理教育工作等领域符合纳入标准的18名专家,进行2轮专家函询.结果 2轮专家函询问卷回收率分别为90％和100％,2轮专家权威系数均为0.886,2轮专...     

基于新型冠状病毒肺炎医院隔离观察区防护监控护理敏感指标的构建

目的构建科学、实用的基于新型冠状病毒肺炎(简称"新冠肺炎")医院隔离观察区防护监控护理敏感指标。方法以国家政策文件、国家最新诊疗方案及国家最新防护指南等为指导,同时查阅最新文献,结合本院新冠肺炎隔离观察区的实际情况,通过德尔菲法对15名专家进行两轮专家函询,构建基于新冠肺炎医院隔离观察区防护监控护理敏感指标。结果两轮专家函询专家积极系数均为100%,专家权威系数为0.95,专家总体协调系数分别为0.156和0.220(P0.05);建立了基于新冠肺炎医院隔离观察区防护监控护理敏感指标,包括8个Ⅰ级指标,50个Ⅱ级指标;第2轮专家函询后Ⅰ级指标变异系数为0.000～0.111(平均值0.064),Ⅱ级指标变异系数为0.000～0.115(平均值0.044)。结论建立了基于新冠肺炎医院隔离观察区防护监控护理敏感指标,构建过程科学合理,具有实用性,为更好地指导临床实践提供了参考。     

护理硕士专业学位研究生导师准入及岗位胜任力评价指标体系的构建

目的 构建护理硕士专业学位研究生导师准入及岗位胜任力评价指标体系.方法 在文献综述的基础上,通过专家小组讨论初步拟定指标体系.运用德尔菲法,选取26名护理教育、护理管理、临床护理领域的专家进行2轮函询,采用层次分析法确定指标权重.结果 2轮函询问卷回收率分别为85.7％、86.7％,肯德尔协调系数分别为0.254、0....     

消化内科护理质量敏感性指标体系的构建

目的 建立敏感、科学、实用的消化内科护理质量敏感性指标评价体系,为消化内科护理质量评价提供参考依据.方法 通过文献查阅法和专家访谈法,在循证基础上初步建立消化内科专科护理质量敏感性指标体系草案,并且设计专家函询问卷表.通过德尔菲专家咨询法(Delphi法)以电子邮件或见面的形式向专家发放函询问卷表,收取第1轮函询问卷表后,根据专家的意见及指标筛检标准对部分条目进行删除、扩展和修改,形成第2轮函询问卷表,经过2轮专家函询,对数据进行统计分析,最终确定消化内科专科护理质量敏感性指标评价体系.结果 2轮函询中,问卷回收率分别为93％、100％,权威系数分别为0.854、0.866,第2轮函询后全部指标重要性评分、可操作性评分及计算公式合理性评分均数均>4,变异系数为0.10～0.18,专家认同度均≥90％,构建了24项消化内科护理质量敏感性评价指标体系.结论 构建的消化内科护理质量敏感指标评价体系具有较高的科学性和可靠性,为护理管理者进行消化内科护理质量评价提供客观、可量化的依据.     

ICU方向护理硕士专业学位研究生培养方案的构建

目的 构建基于新入职护士培训的ICU方向护理硕士专业学位研究生培养方案,为实现护理硕士专业学位研究生培养与新入职护士培训的并轨奠定基础.方法 通过文献分析法拟定ICU方向护理硕士专业学位研究生培养方案初稿,采用德尔菲法对25名专家进行2轮函询.结果 2轮函询专家积极系数分别为93.3%和89.3%,专家权威系数均为0.91,各项内容变异系数为0.06~0.24.ICU方向护理硕士专业学位研究生培养方案包括课程设置、教学时间安排、临床实践内容3部分.结论 培养方案具有较好的科学性,为护理硕士专业学位研究生教育改革提供新思路.     

突发公共卫生事件应急院内院前急救护理实训基地培训课程体系的构建

目的 通过德尔菲法构建突发公共卫生事件应急院内、院前急救护理实训基地培训课程体系。方法 通过文献分析、专家讨论形式初步形成培训课程指标,采用德尔菲法对20名急救专家进行2轮函询,统计分析整理专家意见,确立最终课程指标体系。结果 2轮专家函询的问卷回收率分别为95.23%、100%,专家积极性较高。专家权威性系数为0.93,专家Kendall′s W系数为0.115～0.258(P<0.01)。课程体系包括1级指标4项(突发公共卫生事件应急理论知识、突发公共卫生事件应急操作技能、突发公共卫生事件心理救援、突发公共卫生事件急救情景模拟演练)、2级指标16项、3级指标48项。结论 本研究专家积极程度、专家权威程度及专家意见协调性均较好;为突发公共卫生事件应急院内、院前急救护理培训提供了系统化、规范化的理论参考及实践指导。     

高等中医药院校护理本科生中医护理临床实践培养体系的构建

目的 构建高等中医药院校护理本科生中医护理临床实践培养体系.方法 通过文献回顾和小组讨论,拟定高等中医药院校护理本科生中医护理临床实践培养体系条目,采用德尔菲法对20名中医护理专家进行2轮函询.结果 2轮函询问卷有效回收率分别为80％(16/20)和100％(16/16),专家权威系数为0.87,2轮专家意见肯德尔和谐...     

研究型医院护理学科建设评估指标体系的构建

目的 构建研究型医院护理学科建设评估指标体系,为研究型医院护理学科评估提供参考依据.方法 通过查阅文献、专家小组讨论和2轮德尔菲专家咨询,确立研究型医院护理学科建设评估指标体系.结果 2轮函询问卷的有效回收率分别为86％和94％;专家的权威系数为0.91;第1轮函询中,一、二、三级指标及总体指标重要性的肯德尔和谐系数分...     

基于德尔菲法构建下肢深静脉血栓形成中西医结合临床护理路径

目的:探讨基于德尔菲法构建下肢深静脉血栓形成中西医结合临床护理路径.方法:通过文献回顾、病历回顾,构建以时间轴为横轴、对应的护理项目为纵轴的下肢深静脉血栓形成中西医结合临床护理路径,通过小组讨论,遴选15名血管专家进行2轮专家函询.结果:2轮专家函询问卷回收率分别为93.3％、86.7％;专家权威系数为0.87,构建6...     

严重腹部创伤患者损伤控制复苏护理方案的构建

目的基于损伤控制复苏理念,构建严重腹部创伤患者损伤控制复苏护理方案。方法通过文献回顾、临床观察及头脑风暴等方法,整合腹部创伤相关指南和文献,制订护理方案初稿,经德尔菲法专家函询,确定严重腹部创伤患者损伤控制复苏护理方案。结果2轮专家函询中,专家积极系数分别为88.89%、100%,专家权威系数均为0.88,2轮函询条目的肯德尔和谐系数分别为0.29、0.32,最终形成的护理方案包括2项一级条目,15项二级条目,50项三级条目。结论本研究构建的护理方案具有科学性、可靠性及适用性,可为临床创伤护理提供指导。     

Adverse events after BNT162b2 mRNA COVID-19 vaccination in health care workers and medical students in Japan

To control the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the promotion of vaccination is important. However, adverse reactions following vaccination remain a concern. To investigate adverse events in the vaccinated Japanese population, we conducted a survey-based study among health care workers, including medical doctors and nurses; other medical staff; and medical university faculty, staff, and students in a single medical school and affiliated hospital in Japan. In addition, we analyzed the association of different adverse events with individual factors (e.g., age, sex) by performing network analysis. While young age and female sex are often considered risk factors for more severe adverse events, the regression models showed neither age nor sex was associated with local injection-site reactions after the second dose in this study. In contrast to local reactions, systemic adverse events were associated with young age and female sex. However, myalgia was unique in that it was not associated with younger age even though the network analysis showed that myalgia was consistently related to arthralgia and belonged to the group of systemic events after both the first and second vaccine doses. Further study is needed to ensure safe and effective vaccination to aid in controlling the COVID-19 pandemic.     

Smallpox Vaccination: A National Survey of Emergency Health Care Providers

Concerns about bioterrorism have prompted a national voluntary smallpox (SP) vaccination program in the United States. Although emergency health care providers are among the first targeted for vaccination, little is known about how these providers view the risks and benefits of SP vaccination. OBJECTIVES: To assess the willingness of emergency health care personnel to receive pre-event SP vaccination prior to the start of the national program. METHODS: The authors conducted a national cross-sectional, anonymous survey of 1,701 emergency physicians, nurses, and mid-level practitioners working full time in 13 adult and pediatric academic emergency departments in large U.S. cities in November and December 2002. The main outcome measure was willingness to be vaccinated against SP. Secondary outcomes included the prevalence of self-reported contraindications, and reasons for and against vaccination. RESULTS: 732 emergency health care providers returned questionnaires (response rate 43%). Overall, 73% (95% CI = 66% to 80%) were willing to receive pre-event SP vaccination. 18% (95% CI = 14% to 23%) reported contraindications to vaccination, and 50% (95% CI = 39% to 61%) of these providers were willing to receive pre-event SP vaccination. Self-protection (72%) was the most common reason cited for desiring vaccination against SP; concern about vaccine-related adverse events (54%) was the most common reason cited for not wanting immunization. CONCLUSIONS: Most emergency health care providers express a willingness to receive pre-event SP immunization; self-protection is a principal motivating reason. A subset of health care providers, however, may place themselves at increased risk by desiring vaccination despite contraindications.     

Incidence of adverse reactions to COVID-19 vaccination:A meta-analysis of randomized controlled trials

Objective:To systematically evaluate the incidence of adverse reactions to coronavirus disease 2019(COVID-19)vaccination.Methods:We systematically searched PubMed,Embase,The Cochrane Library,Web of Science,CNKI,WanFang Data,and VIP Database from the inception of each database to August 31,2021.Randomized controlled clinical trials(RCTs)on the safety of different types of COVID-19 vaccines were retrieved and analyzed.A random or fixed-effects model was used with an odds ratio as the effect size.The quality of each reference was evaluated.The incidence of the adverse reactions of the placebo group and the vaccination group was compared.Heterogeneity and publication bias were taken care of by meta-regression and sub-group analyses.Results:A total of 13 articles were included,with 81287 subjects.Compared with the placebo group,the vaccination group showed a higher combined risk ratio(RR)of total adverse reactions(RR=1.67,95%CI:1.46-1.91,P<0.01),local adverse reactions(RR=2.86,95%CI:2.11-3.87,P<0.01),systemic adverse reactions(RR=1.25,95%CI:0.92-1.72,P=0.16),pain(RR=2.55,95%CI:1.75-3.70,P<0.01),swelling(RR=4.16,95%CI:1.71-10.17,P=0.002),fever(RR=2.34,95%CI:1.84-2.97,P<0.01),fatigue(RR=1.36,95%CI:1.32-1.41,P<0.01)and headache(RR=1.22,95%CI:1.18-1.26,P<0.01).The subgroup analysis showed the incidence of adverse reactions of the vaccination group after injection of the three COVID-19 vaccines(inactivated viral vaccines,mRNA vaccines and adenovirus vector vaccines)was higher than that of the placebo group,and the difference between the placebo group and the vaccination group in the mRNA vaccine subgroup and the adenovirus vector vaccine subgroup was statistically significant(P<0.01).The incidence of adverse reactions after injection of COVID-19 vaccine in subgroups of different ages was significantly higher than that in the placebo group(P<0.01).Conclusions:COVID-19 vaccines have a good safety,among which adenovirus vector vaccine has the highest incidence of adverse reactions.Both adolescents and adults vaccinated with novel coronavirus vaccine have a certain proportion of adverse reactions,but the symptoms are mild and can be relieved by themselves.Our meta-analysis can help boost global awareness of vaccine safety,promote mass vaccination,help build regional and global immune barriers and effectively curb the recurrency of COVID-19.     

“护理应急管理”在新型冠状病毒肺炎突发公共卫生事件中的应用

通过积极动员、可持续的梯队建设和培训演练完成团队建设。制定COVID-19应急制度,建立应急预案、病区管理、多级质控完成突发公共卫生事件定点医院护理部应急队护理人员工作纲领、质量控制管理体系。通过磁性管理,人文关怀做好一线护理人员的心理支持。将科学管理应用到应对COVID-19的应急护理管理中,提高护理应急队伍的反应速度,提升队员应对能力,从而更好地应对各种突发公共卫生事件。     

应急救援护理能力评价指标体系的构建

目的通过科学的研究方法,构建医学应急救援中护理能力评价指标体系。方法采用德尔菲(Delphi)法对23名专家进行两轮问卷咨询,用文献资料法、层次分析法分析各指标的权重。结果专家咨询的权威系数为0.83,判断系数为0.85,专业知晓程度为0.88,专家接受度均>90%;确立应急救援中护理能力评价一级指标5项、二级指标10项、三级指标35项,一、二、三级指标的协调系数分别为0.489、0.437、0.383。结论应急救援护理能力评价指标的条目专家意见统一,研究可信度高,为医院应急救援队护理人员的抽组、培训、考核提供了依据,为应对突发事件提供快速有效的救援护理提供了保障。     

Adverse reactions to the first and second doses of Pfizer-BioNTech COVID-19 vaccine among healthcare workers

IntroductionIn the current coronavirus infection 2019 (COVID-19) pandemic, the messenger RNA vaccines have been shown to help protect high-risk groups from COVID-19. Among healthcare workers vaccinated with Pfizer-BioNTech COVID-19 vaccine, a survey was conducted to analyze the relationship between the incidence and severity of adverse reactions after vaccination.MethodsWe conducted a prospective self-reported survey of adverse reactions among healthcare workers vaccinated with the Pfizer-BioNTech COVID-19 vaccine (Comirnaty®) in Japan. After the first and second dose of vaccine, local and systemic reactions for 8 days after vaccination were reported by volunteer participants using a website. After receiving vaccination, 374 respondents participated in this matched-pair study.ResultsBoth the incidence and severity of adverse reactions tended to be higher after the second vaccine dose than after the first dose. However, the incidence and numeric rating scale (NRS) score of muscle and skin pain were nearly the same after the first and second doses. In a comparison by sex, women had significantly higher incidence and NRS scores for adverse reactions such as headache, skin pain, erythema, and itching. The results also showed that younger age groups had higher incidence rates and NRS scores for all adverse reactions investigated, except for muscle pain, compared with older age groups.ConclusionSome adverse reactions to the Pfizer-BioNTech Comirnaty® COVID-19 vaccine showed gender and age differences. However, generally speaking, all side reactions disappear within a week. Therefore, these side reactions are not a significant concern in recommending vaccination.     

无缝隙护理管理在社区预防接种中的应用

目的:通过对预防接种的儿童进行无缝隙护理管理,保证护理安全,提高服务质量。方法:选择515例2011年接受预防接种的儿童为对照组,实施常规护理流程;选择612例2012年进行预防接种的儿童为观察组,观察组在对照组的基础上给予产后访视中的计划免疫管理,接种前、中、后护理管理,电话随访管理。比较两组接种后不良反应发生率与家长满意度。结果 :观察组接种后的不良反应率低于对照组(P<0.01),家长满意度提高(P<0.01)。结论:加强预防接种过程中的无缝隙护理管理,可以降低儿童的不良反应发生率,提高护理满意度,使护理质量得到持续改进。     

1例AML-M2a单倍体造血干细胞移植后患者 感染新型冠状病毒的护理

总结1例单倍体造血干细胞移植后患者感染新型冠状病毒的护理经验。包括个性化经鼻高流量氧疗、应用新型抗病毒药物、兼顾免疫抑制及针对药物不良反应的护理措施；应对皮肤排斥反应、营养支持、消毒隔离与保护性隔离、人文关怀等护理经验。经一周的治疗患者新冠病毒核酸检测转阴性，CT检查结果示两肺感染性病变较前明显好转，无其他并发症，最终好转出院。我们案例报道以期为新型冠状病毒常态化管控下造血干细胞移植后患者感染重型病例的护理提供经验。     

无缝隙护理在社区计划免疫预防接种中的应用效果观察

目的 观察无缝隙护理在社区计划免疫预防接种过程中的应用效果。 方法 选取2016年5月-2017年2月计划免疫预防接种对象126例,采用随机数字表法分为观察组63例和对照组63例。对照组给予常规护理,观察组实施无缝隙护理干预。比较2组接种疫苗后不良反应发生率和家长的满意度。 结果 观察组不良反应发生率低于对照组(χ²=11.649,P=0.001),家长满意度高于对照组(Z=-2.791,P=0.005)。结论 无缝隙护理在社区计划免疫预防接种过程中的应用效果较好,能够有效降低免疫预防接种不良反应的发生率,提高家长的满意度。